ADHD, Impulse Control, and Discipline

[Sierra]

Ranty and thus very long...apologies in advance.

We are waiting for her evaluation appointment, but I am about 90% positive my four year old has ADHD. She has a long and complicated life story that includes a number of prenatal risk factors for ADHD.

Right now I have shut myself in my bedroom to cool off. My dw is out of town. Last night while I was doing dishes, dd tore the living room apart. Completely. She took puzzles, opened up the boxes and dumped them. She took bins of toys and dumped them. She ripped the books off the book shelves and threw every single book across the room. She climbed on the couch and knocked framed pictures off the wall (fortunately nothing broke). She took board games and dumped them. I swear we never keep many toys out at one time, but she dumped everything she could find, and I came in after ten minutes and I couldn't see the floor.

I tried to get her to clean last night (either with or without my help...I just felt it would be the wrong message for me to clean it up on my own), but it was getting late and when it became a major battle I decided just to put her to bed. I figured we'd both have an easier time facing the mess in the morning.

So this morning I woke up ill. I had such bad abdominal pain that I considered calling for an ambulance. I was doubled-up in pain and vomitting. I am not sure what made me ill, but I don't remember ever having stomach pain like this in my life. It was really bad. Luckily I woke up early enough that with some warm ginger water I was able to get things under control by the time the kids woke up, and I had them hang out on my bed and watch movies on the computer until I felt well enough to go make breakfast. (I'm not longer vomitting and in such bad pain, but my tummy is definitely tender even now.)

After breakfast I talked with dd about cleaning up, and I could tell she was too overwhelmed to do it on her own. It just wasn't going to happen, and I was going to set myself up for frustration if I tried to make her (even by just charging her quarters for my time cleaning up, which we discussed as one option). So 5 year old ds very generously said he would help dd if I would, and we all decided to do it together.

Cleaning with dd is infuriating. She picks something up eight times and never puts it away. She starts putting something away and gets distracted and starts playing with it. She wanders the room aimlessly, passing by countless opportunities to pick things up. She even wanders out of the room every couple minutes and has to be wrangled back in. It's less work to do it myself, but I really felt she needed to be part of the solution to the problem she created. So ds and I spend a half hour or 45 minutes pretty much cleaning up ourselves. dd probably actually put something away successfully four times. Once the room started to look really manageable, I told dd that ds and I had done enough and that she needed to finish the room. So she goes to something that needs to be cleaned up and starts playing with it. And so the story goes...on and on...though I suppose this is getting long and that I should get to the point.

With ds, even though he has developmental delays, there are many discipline options. I can take any number of approaches to solving the issue. But so little of it works for dd. For example, with ds I could say, "I am happy to clean this up for you, but you will owe me eight quarters for the job. If you'd rather not spend the money, I suggest you clean up the mess." But dd doesn't have the abillity to think outside the moment, and she really struggles with impulse control, so that would just result in her giving up the money, throwing a huge tantrum later about not having the money, and *still not learning from the experience.* That's the thing. I wouldn't mind her giving up the money or even the huge temper tantrum if it meant she was actually learning. But past experience tells me that she doesn't have the ability to think of cause and effect in that way.

Any discipline tips?

[Multimomma]

For example, with ds I could say, "I am happy to clean this up for you, but you will owe me eight quarters for the job. If you'd rather not spend the money, I suggest you clean up the mess." But dd doesn't have the abillity to think outside the moment, and she really struggles with impulse control, so that would just result in her giving up the money, throwing a huge tantrum later about not having the money, and *still not learning from the experience.* That's the thing. I wouldn't mind her giving up the money or even the huge temper tantrum if it meant she was actually learning. But past experience tells me that she doesn't have the ability to think of cause and effect in that way.

Yeah, that's not going to happen. I have a kiddo with adhd, and you can't say 'clean up'. You've heard the saying "Can't see the forest for the trees"? Kids with adhd can't see the trees, for the forest. They see 'mess', not 'puzzle piece', 'book', 'dish', 'sock'. It's too much for their brains to process.

If it makes it easier for now, know that it does get better. Like any other development, adhd is aided by added maturity and with training. For my son, at age four, we could only tell him one thing at a time. (and LOTS of four year olds are like this) And it couldn't be "Put that away", it had to be "Pick up the blue puzzle pieces and put them in this bin" while I helped him by pointing out pieces AND holding the bin. Now, at newly nine, I can give him a list of five things to take care of immediately, then he reports back to me while I'm in another room, and it's taken five years of teaching to get there!

If she's a whirlwind while separated, I would keep her with me if there was no one else to keep her busy. Instead of doing dishes alone, either have her help or set up tasks in the kitchen to keep her busy. Kids with adhd are always clicking, they don't relax, it's not in their wiring! With my son we did a LOT of lego creations in a rubbermaid bin on the floor. I'd make assignments like "Build the longest snake you can make" or "Make a car with seven wheels". And that's training too because after each creation he had to remember (or be reminded) to put it back into the bin.

[RiverTam]

I'd parent her as if she were two years younger than her actual age. I know she's 4, but I'd treat her like she's 2. That behavior is about what you'd expect from a 2 year old.

In some kids with ADHD, the prefrontal cortex in a kid with ADHD delays later than the prefrontal cortex in an "average" kid. (Gifted kids have this problem, too.) The prefrontal cortex has a lot to do with executive function, so these kids have judgment that is delayed by around 18 -24 months on average. Their brains are literally younger than their chronological age. They can't help their immaturity.

Here's a story on this in gifted kids: http://www.foxnews.com/story/0,2933,189532,00.html

Here's a story on this in ADHD kids:
http://www.psychtreatment.com/ADHD_b...cal_causes.htm

[Sierra]

Thanks for your responses. I failed to mention in my original post the many various ways I tried to get her to cleanup both in the evening and in the morning. I definitely tried the old, "pick up the blue blocks" trick and even "please take this car that is in my hand and put it away."

dd has very little unsupervised time because I know how she is, but it is hard sometimes to get her seperated from her brother, and he doesn't always want to be glued to my hip, you know? My kids are eleven months apart and very much like twins, especially with dd being mildly on the "gifted" side (she's been reading since she was 3, is able to do basic addition and subtraction word problems in her head, etc) and my ds being on the delayed side. I guess I need to work more on finding ways to keep the kids engaged in the same room as me when I am cleaning and stuff. It is just so dang tiring, so I guess I just need to whine before I go and do it LOL. Thanks for the links RiverTam. dd defnitely has some prefrontal cortex/executive function issues. I think the challenge in treating her like she is two is that she is so-definitely-not-two academically and in any way that doesn't require executive function. I feel badly for her.

The sad thing is, dd is highly motivated to do the right thing. I feel awful when I get frustrated because I know that she wants to do better but just can't figure out how to do it.

[Sierra]

P.S. dw came home this afternoon and noticed that dd is being even more hyperactive than usual, and lacking even more attention than usual. We realized she has been having more sweets lately due to out of town guests, going over to the IL's house, etc. She does seem to have more difficulty when she has eaten sweet stuff, so we're hoping things will ease as the week goes on.

P.P.S. Will she ever learn? Anything requiring executive function is delayed for her. Will she eventually mature into the ability to plan, perceive cause and effect, etc. or will she struggle through her life in this way?

[bbsc]

My son doesn't have ADHD, but we do have some of the same issues with tearing the house apart. About 6 months ago I had to put baby proofing door knob locks on all the closets. And I keep a large percentage of the toys inaccessible, without an adult's help.

I'm really lucky to have a locked storage area at my apartment too, so toy overflow goes in there. We get out a few things at a time, like just the legos and trains if he wants to build a city. Or the puzzles. Just not so much that the clean up is overwhelming. And he still needs a lot of help with cleaning up, and sometimes he can't even help me without having a meltdown. In those situations, I will clean up after he goes to sleep.

[joensally]

With DS, we put magnet locks on a whole lot of stuff and provided a whole other level of supervision. We knew he couldn't manage on his own at that age. The discipline approach we employed at that age was avoid, avoid, avoid and coach, coach, coach.

DS does have EF issues which have improved with age and a lot of coaching. We recently had two sets of relatives staying with us and they couldn't believe the changes.

Here are some great books with previews:
http://books.google.com/books?id=J5M...page&q&f=false

http://books.google.com/books?id=DmU...page&q&f=false

Plus:
http://books.google.com/books?id=pXf...ed=0CCUQ6AEwAA

I also highly recommend the Eides and their various resources:
http://www.mislabeledchild.com/

I love Kurcinka's Kids, Parents and Power Struggles as well.

I would liberally repeat the word "asynchrony" in my mind to remind myself that my child was all over the place developmentally and that I needed to parent him where he was, and that it often didn't make sense to me - it just was. In some respects he was like a 2 year old, in others a 4 year old, and others a 6 year old.

[buttercup784ever]

My ds(7) is exactly like your dd. It's like a tornado hit the room after he's done, and he can't focus enough to pick it up. I have a 'one toy in the living room at a time' rule, and no toys are stored in there so our living area is usually ok. But his room....oy..

I have broken down different levels of cleanliness for him, and he has different levels of supervision for each level. Level 1 is basically "Make room for me to walk". He can do this on his own. All he has to do is push stuff aside and make a path and make sure I can get to his drawers and closet.

Level 2 is when I see particular messes he needs to clean. Luckily he loves to 'race' so I'll set the timer and tell him he has three minutes to pick up all the books on the floor. I don't stay and watch to keep him on task anymore, but I used to do that. No conversation about anything but where the books go.

Level 3 is sorting and putting away which I supervise. We make different piles of items and then put each pile away. He helps me do this, but it's very distracting to see toys he hasn't played with in awhile because they were shoved under his bed. I've found that working FAST helps. If I keep the energy level very high he seems to work better. We don't stop and talk about anything it's just, 'pick up the car, put it in the car pile, pick up the game piece, put it in the game pile', but we go in spurts. Work for about 10 minutes and then go and do something else.

[jaxxy]

Now, at newly nine, I can give him a list of five things to take care of immediately, then he reports back to me while I'm in another room, and it's taken five years of teaching to get there!

Thank you for saying this. It may have taken 5 years to get there.... but you got there! We have hope!

[cdahlgrd]

Yep, been there done that.

I have a 5 minute toy rule: There can only be the amount of toys available, that I can put away in 5 minutes. The rest go into cuboards or the garage. Then we switch buckets of toys regularly.

I also have 2 kids who work really hard to avoid picking up, and 2 who are really willing to help. I make sure to guide my avoiders into picking up their share, even if I have to show them 1 toy at a time. My oldest is 9 and is now pretty good at helping. My 5 year old is getting there if I break a task down (pick up the laundry/shoes/legos).

I also used lots of natural consequences. "Sorry honey, if you pull all the toys out, and won't help put them away, then they go into the garage until you are able to care for them."

I wouldn't let a child "buy" your help. That one may bite you after a couple years. You don't want a 18 year old paying you to clean his room, you want him able to do it himself.

There is hope. But until it gets better, lock away some stuff and supervise supervise supervise! (sorry, I know how hard that is, but it will get better!)

[pumpkingirl71]

Oh Seirra, I came here to ask a question about adhd meds and I saw this. to you. I could have written your post two years ago. We had a newborn on top of the adhd thing hitting critical mass. After two very scary incidents with the baby, we decided to turn to medication. It has changed our world. As a public school teacher, I had come to hate ADHD drugs. But today I feel that they have saved my daughter and my family.

I really agree with the poster who said to treat dd two years younger than she it. Believe me, I know how hard that is with a gifted kid.

I won't kid you, our family is just surviving on some days, but we have come to the conclusion that disciple is what we use to keep the rest of the family safe and calm. We use timeouts. They don't seem to help dd, but the rest of us get breathing space and tempers are less likely to rise.

Right now, we are at a place where dd is holding things together pretty well, but mornings and night are a nightmare. So this suggests that a new med might be the answer. But I am terrified at the thought of changing anything. We have cobbled together a functioning family life and I don't want to rock the boat. Not sure how healthy that is....

And your post really made me see how far my dd has come. So time really does help. Also, we focus on therapy, in hopes that it will help too. Where is the ADHD eval being done?

[pumpkingirl71]

Originally Posted by Sierra

The sad thing is, dd is highly motivated to do the right thing. I feel awful when I get frustrated because I know that she wants to do better but just can't figure out how to do it.

This is where our girls are very different. My daughter is very defiant and gets more so as I see her spin out of control.

[J. Jones]

I just read this book: The Gift Of ADHD: How To Transform Your Child's Problems Into Strengths. It talked a lot about loving the child you have because a big risk with ADHD symptoms in children is that they lose the connection with the parent who increasingly views the child as a series of problems. The book says it better.

Anyways, from reading your post, it sounds like your expectations are a little high for the 4yo. It sounds like she was able to make a huge mess - was she unsupervised for a long time? Sounds lonely. From my reading of the story, it seems like she might feel very disconnected. Does she need a lot more hugs, even at the risk of teaching her she's loved unconditionally?

Best of luck! She sounds like gem!

[Sierra]

Thanks for the continued responses. I have been reading and reflecting. Only a few responses, but please do know I have read and taken to heart everyone's advice.

Originally Posted by pumpkingirl71

This is where our girls are very different. My daughter is very defiant and gets more so as I see her spin out of control.

Your daughter and mine have some similar issues aside from the ADHD, and I totally know what you mean. I see that in other ways/scenarios with my dd, though I have to say that the PCIT worked miracles in terms of the motivation toward positive things.

Originally Posted by pumpkingirl71

And your post really made me see how far my dd has come. So time really does help. Also, we focus on therapy, in hopes that it will help too. Where is the ADHD eval being done?

Actually, when you asked this question I remembered that you had PM'd me a while back the name of a doctor (therapist or developmental ped maybe?) with whom I never followed up. The big hospital in my city has a department that specializes in these types of evals, supposedly, so that is where I have set things up. Now I think I'll go take a look back at my PMs just to make sure the name you sent me wasn't for someone who does these evals.

Originally Posted by cdahlgrd

I wouldn't let a child "buy" your help. That one may bite you after a couple years. You don't want a 18 year old paying you to clean his room, you want him able to do it himself.

LOL Yeah, I totally know what you mean. So far, so good. My kids know that I am not always up for being paid to do work for them. They know that they can't just buy their way out of things. But on occassion I do offer to do something for them...usually for free, on rare occassion for some wage. It's the same in reverse. They know contributing to the family is an expectation for all of us, everyday, and that we don't get paid for that. But every once-in-a-blue-moon for a special job I will pay them some coins from my coin jar.

Most of the time they don't have money .

Originally Posted by J. Jones

I just read this book: The Gift Of ADHD: How To Transform Your Child's Problems Into Strengths. It talked a lot about loving the child you have because a big risk with ADHD symptoms in children is that they lose the connection with the parent who increasingly views the child as a series of problems. The book says it better.

I appreciate the suggestion, but you won't find a parent who has worked harder on her connection with her kid. My dd arrived in our lives with attachment issues, so we have spent a lot of time working on becoming and staying connected. Hours and hours of therapy, and daily therapeutic homework to nurture our bond as well as a good amount of one-on-one playtime together.

Does my dd always get 100% of my focus? No, my time is divided between my children. And sure, there are times when I need to sharpen my focus when I am with her (my head isn't always 100% in the game...whose is?), but like I said, you won't find a parent who has worked harder on this.

Anyways, from reading your post, it sounds like your expectations are a little high for the 4yo.

I'm not sure what you think I am expecting my child to do that is too high of an expectation. Please re-read my posts, especially my second one in which I explain how I walked through the cleanup with my child one toy at a time.

It sounds like she was able to make a huge mess - was she unsupervised for a long time?

I know my post was long, but I did say that she was in the living room for ten minutes. I was doing dishes.

Sounds lonely.

She was with her brother. He almost always comes and gets me if something like this is going on, but for some reason he didn't this time.

From my reading of the story, it seems like she might feel very disconnected. Does she need a lot more hugs, even at the risk of teaching her she's loved unconditionally?

Do you have a child with ADHD?

You are making a lot of assumptions from this tiny thumbnail from my life.

Best of luck! She sounds like gem!

She is, and I love her dearly.

[Sierra]

By the way, I should post an update. While I was taking my break, both kids took a break too. After I wrote my post, I went back to spending time with the kids. We didn't talk about the mess, we just hung out in my bedroom. Finally I mentioned the mess, and I asked dd what she needed in order to successfully be able to complete the job. She said, "It's almost done mom, I know that. I will go do it. When I tell you it is done, you come and check." I offered to go with her, but she asked to do it by herself. So she went and worked on it, and then she came back saying it was done. I went down, and I could see she had finished the last few pieces on the floor but that she'd forgotten to put away some items left on the couch. I told her that it looked great and that all she had left were the things on the couch. And she did it. She put the rest of the items away.

I am really proud of her for the way she handled it in the end, and I told her how much I appreciated the way she finished the job. For any four year old to do that would be great, but considering the things this kid has to struggle with, it is off the charts amazing as an accomplishment. I think I handled the situation overall pretty well as a parent too.

[columbusmomma]

Reading this thread with interest and anxious to read some of the books suggested. My Ds, age 8 has adhd and I'm right here with you all!

[pumpkingirl71]

In case it saves you some digging, the dr. that we see for impulsivity (I think that there is some arbitrary age thing with using the term ADHD) is Dr. Albers-Prock at Children's Hospital Boston. She runs the Adoption Program and works with another dr. to do a full developmental/behavioral/psychological eval of kids who come in. Not 100% happy with the program, but it is pretty awesome to work with a dr. that understands the complications of adopted children. For therapy, we use Children's Charter in Waltham.

We should trade, tell me the name of the therapy you did in Cambridge!

Good Luck

[Sierra]

That was PCIT with Kristina Konnath (spelling?) at the Trauma Center in Brookline :-). We did a lot of adaptation of PCIT in order to fit our family values and needs, and Kristina was very willing to tailor things.

[J. Jones]

Ok then!

But you were asking for discipline techniques, as if that would solve your problem.

I don't know any parent who couldn't be helped by digging a little deeper into the love and attachment reservoirs, especially those of us w challenging kids.

Also. ADHD kids are especially emotionally astute. Everything in your post screams "fed up" - she knows this is how you feel...kinda makes me want to tear apart a room too - lol...really though, her actions may be partly a manifestation of the underlying emotions in her home.

Peace to you! Sorry if I was pushing yr buttons.

[Sierra]

Originally Posted by J. Jones

Ok then!

But you were asking for discipline techniques, as if that would solve your problem.

Yes, I was. Specifically, I was hoping for tips on helping children who have impulse control challenges learn to make choices that positively benefit them in the long-term, even if they require harder work in the short term. I was also hoping someone might have information about helping children with ADHD -- not any "challenging kid," but a kid whose prefrontal cortex is shaped by ADHD -- to actually learn from the natural or logical consequences they experience from their actions.

The origin of the word "discipline" is to guide/teach. That's what I meant when I used it, and I shouldn't have to explain that on a natural parenting website that focuses on "gentle discipline." I think we can assume of one another, that this is generally what we are talking about when we talk about discipline.

I received helpful responses from many posters. I didn't hear anything new, but I received some good reminders.

I don't know any parent who couldn't be helped by digging a little deeper into the love and attachment reservoirs, especially those of us w challenging kids.

Sure, we could all dig a little deeper in countless areas of our life (though I must say, as much as some folks could dig deeper with attachment, rare would be the parent whose deficit is love for their child...and I certainly don't think any parent on this site, who comes here seeking help because she knows she needs it when she is tired and burnt out by an acute issue, deserves to have her love for her child questioned...that's mean beyond a level I've seen here in a while). However, let me introduce you to a parent who has worked for years on a therapeutic level on attachment with her child...the digging has been done, friend.

You didn't take the time to ask, without judgement, what happened before I went to the kitchen to do dishes. You didn't take the time to ask what our family's day had been like or anything that qualified you to call my daughter lonely and to say that the problem is she isn't loved unconditionally.

The issue that prompted me to make my post didn't stem from not loving my child or not being attached enough to my child. It stemmed from my child spending ten minutes with her brother in the living room while I did the dishes. She wasn't lonely. She had my attention for most of the day, including in the moments prior to me going into the kitchen. She had her brother keeping her company while she was in there, and she enjoys his company and is often able to play with him happily. The issue stemmed from her pouring out or throwing one thing and liking how that felt, and not having the impulse control or planning capacity to prevent herself from doing it again and again until the mess took over the living room.

The issue was resolved with me at her side. I never abandoned her. I never stopped loving her or being loving even as I disciplined. I walked her through it a step at a time. I took a break when I was frustrated and needed a break. I vented to someone other than my child to let off a little steam. I did what good, loving parents do.

Also. ADHD kids are especially emotionally astute. Everything in your post screams "fed up"

Well, as an adult with some ADHD challenges, let me tell you that everything about your post screamed righteousness.

she knows this is how you feel...kinda makes me want to tear apart a room too - lol...really though, her actions may be partly a manifestation of the underlying emotions in her home.

More presumptions. The underlying emotions in our home? How on earth could my post, which was about an accute, short-term incident in our home, have given you a picture of the "underlying emotions" in our home outside of that moment? Or even a full picture of the emotions in the moment? Was I frustrated in that moment? Absolutely. Did I find some of my child's actions infuriating in the moment? Yes. That's why I went to take a break. But did I ever present my frustration to my child in such a way that said my love was conditional? Absolutely not.

There are moments for every parent in which we "lose it" and say or do things we regret. This wasn't one of them for me.

Peace to you! Sorry if I was pushing yr buttons.

You didn't push my buttons. You didn't strike a cord or hit a soft spot. You didn't say something that was true that I wasn't ready to hear. Please. I am having a normal reaction to my love for my child being questioned by someone who doesn't know me and who is responding to a very narrow post on a frustrating moment in trying to teach my child something that is challenging (and silmultaneously keep my house liveable while my spouse was away and I was sick). It would be kind of like if your child was having a tantrum in the grocery store on the one day that you *had* to take your child shopping with you and *had* to get the shopping done in a short period of time, and some stranger came up and said, "Perhaps he doesn't feel loved enough. I'd want to have a tantrum if I had you as a mom too."

I didn't deserve your post, it missed the mark, and it wasn't compassionate or helpful. Perhaps you should think a little longer before posting something to another parent on this board that implies the parent's short-term frustrations are from not loving their child enough or well enough or unconditionally. It's rude, presumptive, and mean.

Bless your heart for trying.